Antipsychotic-Induced Tardive Movement Disorders: A Series of Twelve Cases
Duangjai Kasantikul MD*, Buranee Kanchanatawan MD*
Affiliation : * Department of Psychiatry, Faculty of Medicine, Chulalongkorn University
Background : Prolonged use of antipsychotic drugs (AP) with or without sudden withdrawal as well as high
dosage of AP (at least 3 months) may result in a variety of movement disorders such as classical tardive
dyskinesia (tongue rolling, lip pouting, trunkal choreiform movements), tardive myoclonus(sudden, brief
involuntary jerking), tardive dystonia (tongue protrusion, torticollis, scoliosis, jaw spasm, bruxism, abnormal
trunkal posture, or” Pisa syndrome”, strong contraction of arm and leg). Patients with severe symptoms often
suffer from body pain and fractures of bones due to frequent fallings. They are also accused of “faking” to call
attention or they believe that the symptoms are signs of being “cursed or posses in”.
Objective : To report twelve patients of antipsychotic drug induced tardive movement disorders including
tardive dystonia, tardive myoclonus, and tardive Parkinsonism. Patients were incorrectly diagnosed as epi-
lepsy, conversion (pseudo seizure), or hypochondriasis.
Results : In the present series, there were eight men and four women with age ranging from 13 to 72 years. All
patients had been taking both typical and atypical antipsychotic drugs for at least one year. Strong involun-
tary movement disorders, torticollis, scoliosis, body pain, difficulty in swallowing, and aphonia were observed.
Most patients were thin and anemic. They responded well to diazepam, anticholinergic drug, clonazepam
lithium, and antidepressant while antipsychotic drugs were discontinued in most cases. Calcium salt and iron
supplement appeared to be useful.
Conclusion : Physicians should be aware of these abnormal movement disorders induced by AP drugs to detect
early and provide prompt treatment. AP drug should be used cautiously to prevent this iatrogenic effect
particularly in high- risk patients.
Keywords : Antipsychotic drug, Tardive syndromes, Tardive dystonia, Tardive myoclonus, Tardive parkinsonism
